Dramatic cessation of gross sustained treatment resistant hematuria after [177Lu]Lu-PSMA-617 therapy: A case report

We report a patient with locally invasive metastatic castration resistant prostate adenocarcinoma, which had massive invasion to the bladder and caused frequent gross hematuria. The patient had received more than 10 units of packed cell at the time he was referred for [177Lu]Lu-PSMA-617 therapy, but despite frequent transfusions his serum hemoglobin level had been under 8 g/dl most of the time. He had received first generation androgen deprivation therapy (ADT) from 3 years previously and the second generation since 1 year ago and had undergone multiple procedures for cessation of hematuria, such as multiple cystoscopies, bladder irrigations and angioembolizations. We performed [99mTc]Tc-PSMA whole body and SPECT/CT scan, which demonstrated a large PSMA avid prostate mass invading the urinary bladder wall. All components of the locally invasive tumor were present demonstrating high PSMA avidity, so he was scheduled for [177Lu]Lu-PSMA-617 therapy. One week after the diagnostic scan, therapeutic dose of [177Lu]Lu-PSMA-617 was administered. The patient reported no hematuria 4 days after the [177Lu]Lu-PSMA-617 administration. In the follow up, no recurrent hematuria was reported, too. The PSA level also declined from 40.5 ng/ml to 18.7 ng/ml, 1 month after the first treatment.